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Review
. 2023 Feb:158:231-244.
doi: 10.1016/j.jpsychires.2022.12.025. Epub 2022 Dec 24.

Identifying transdiagnostically relevant risk and protective factors for internalizing psychopathology: An umbrella review of longitudinal meta-analyses

Affiliations
Review

Identifying transdiagnostically relevant risk and protective factors for internalizing psychopathology: An umbrella review of longitudinal meta-analyses

Vivienne M Hazzard et al. J Psychiatr Res. 2023 Feb.

Abstract

Internalizing mental disorders are highly comorbid with one another, and evidence suggests that etiological processes contributing to these disorders often overlap. This systematic umbrella review aimed to synthesize meta-analytic evidence from observational longitudinal studies to provide a comprehensive overview of potentially modifiable risk and protective factors across the depressive, anxiety, and eating disorder psychopathology domains. Six databases were searched from inception to August 2022. Only meta-analyses of longitudinal studies that accounted for baseline psychopathology (either via exclusion of baseline cases or statistical adjustment for baseline symptoms) were included. Methodological quality of meta-analyses was evaluated using the AMSTAR 2, and quality of evidence for each analysis was rated using GRADE. Study selection, quality assessment, and data extraction were conducted in duplicate by independent reviewers. The protocol for this review was registered with PROSPERO (CRD42020185575). Sixty-one meta-analyses were included, corresponding to 137 meta-analytic estimates for unique risk/protective factor-psychopathology relationships. Most potential risk/protective factors, however, were examined only in relation to depressive psychopathology. Concern over mistakes and self-esteem were the only risk and protective factors, respectively, identified as statistically significant across depressive, anxiety, and eating disorder psychopathology domains. Eight risk factors and four protective factors also emerged as having transdiagnostic relevance across depressive and anxiety domains. Results suggest intervention targets that may be valuable for preventing/treating the spectrum of internalizing psychopathology and reducing comorbidity. However, few factors were identified as transdiagnostically relevant across all three internalizing domains, highlighting the need for more research investigating similar sets of potential risk/protective factors across internalizing domains.

Keywords: Anxiety; Depression; Eating disorders; Protective factors; Risk factors; Transdiagnostic.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study Selection Flowchart Note. IV = independent variable; DV = dependent variable.
Figure 2
Figure 2
Risk/Protective Factors Identified as Transdiagnostically Relevant Across Depressive, Anxiety, and Eating Disorder Psychopathology Domains Note. eOR = equivalent odds ratio; CI = confidence interval. eORs > 1.00 indicate risk factors and eORs < 1.00 indicate protective factors.
Figure 3
Figure 3
Summary of Risk/Protective Factors Identified Across Depressive, Anxiety, and Eating Disorder Psychopathology Domains Note. COPD = chronic obstructive pulmonary disease. This Venn diagram summarizes risk/protective factors identified as statistically significant either across domains or for a specific domain. Many factors identified for specific domains were not examined across other domains and thus are not necessarily domain-specific. Due to the large number of risk/protective factors identified for depressive psychopathology, some are grouped into overarching categories in this figure (e.g., dietary patterns); each specific risk/protective factor for depressive psychopathology can be found in Table 3. Refer to Tables 3–5 for information regarding quality of the evidence and effect sizes, including risk versus protective status of each factor.

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